Cytokine Registry Database of Stroke Patients

Stroke is the fifth cause of all-cause mortality in US http://www.cdc.gov/stroke/facts.htm . Early identification and treatment not only prevent mortality but also morbidity. Recent advancement in the imaging and diagnostic technique and novel therapeutic modalities has dramatically helped to downgrade stroke from the list of top mortality index in the last 3 years. However, studies determining factors which help predict stroke outcome are still underway and much work needs to be done in this direction. Many factors currently are used to predict stroke outcome with varying results, for e.g. NIHSS is a good predictor of stroke outcome at 3 months; however, we need better predictors, outcome scales or outcome measures which are easy, reliable and has better specificity and sensitivity.

There is also some correlation of clinical and biochemical predictors in subarachnoid, cerebral venous thrombosis including Hunt and Hess, SAH score, WFNS-SAH grading among others with variable predictive quality. (Rosen et al; Neurocritical Care; April 2005, Volume 2, Issue 2, pp 110- 118: Subarachnoid hemorrhage grading scales).

During the acute phase of focal cerebral ischemia, there is an elevation of thrombin activity and a decline in fibrinolytic activity. Moreover, the role of pro-inflammatory cytokines has been proven in the last few decades, as markers of inflammation have been closely studied in mice models; there are indications that elevated levels correlate with the extent of ischemic injury. Various interleukins were found to be elevated in most if not all patients with acute ischemic stroke. Correlation of hemostatic (procoagulant and fibrinolytic markers) with inflammatory markers is under discussion, with no confirmed common marker identified as of yet.

As new cytokines and tissue markers are established in scientific literature, stroke scientists are interested in evaluating the role of these markers in the pathophysiology of stroke. The role of glial cell markers has been of remarkable interest. Recently, an astrocyte marker S100B has shown association with infarct size, neurological outcome, and prognosis. Moreover, analyzing the cytokines in stroke and ICH patients would help understand their role in the acute phase, which may become potential therapeutic adjuncts for tpa and endovascular thrombectomy. In summary, inflammation in acute stroke is an area of interest in the recent years, with the theoretical benefit of aborting the inflammatory chain during acute stroke might be useful in limiting stroke-related brain damage or hemorrhagic transformation in acute stroke.

Inclusion criteria

• All stroke patients (hemorrhagic and ischemic) presenting within 24 hours of onset who consent to our study.
• Adult Male/Female patients ages >18 years old
• Patients whose standard stroke admission order sets are obtained for clinical care.
• Patients with a history of MS may be included for future subanalysis.

Exclusion criteria

• History of prior stroke or any other neurodegenerative or neuroinflammatory disease (AD, PD, TM, PSP, etc.) except MS.
• Individuals ages <18 year
• Pregnant women
• Prisoners